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At least 397 records · Page 22Linked to original sources
PubMed2004

Successful sentinel node identification in colon carcinoma using Patent Blue V.

AIM: The aim of this study was to evaluate the use of Patent Blue V for identification of the sentinel node in patients with colon carcinoma. METHOD: From May 2002, 35 patients operated for colon carcinoma underwent lymphatic mapping using Patent Blue V as marker. Either directly after resection of the colon or during operation 2 ml of Patent Blue V was injected peritumourally, and the first 1 to 4 blue nodes were marked as sentinel nodes. Pathological evaluation was done on a single HE-stained section of all lymph nodes. Only if all sentinel nodes were negative for metastases, serial sectioning and additional immunohistochemical staining against keratine CK 7/8 was performed to reveal micrometastasis in the sentinel nodes. RESULTS: In 33/35 of patients at least one sentinel node was identified. In 10/33 the sentinel node was positive for metastases, and in 5/10 this was the only node containing metastases. One patient had a false negative sentinel node (accuracy 97%, sensitivity 91%). CONCLUSION: Using Patent Blue V, it is possible to identify the sentinel node in most patients with colon cancer. The results are comparable with other sentinel node studies using Lymphazurin.

Colectomy↗
PubMed1996

Surgical prophylaxis of recurrent stroke in patients with patent foramen ovale: a pilot study.

Prevention of recurrent stroke in adults with patent foramen ovale represents a therapeutic challenge. Antiplatelet or anticoagulant treatment is widely introduced, but its exact indication is not known. In this pilot study, eight men and three women with previous ischemic cerebral events underwent direct surgical closure of the patent foramen ovale. Mean age was 39.4 (from 30 to 58) years. No coexisting cause of stroke was found after extensive investigations, including blood and coagulation tests, echocardiography, 24-hour three-lead electrocardiographic monitoring, extracranial and transcranial Doppler ultrasonography, and cerebral angiography. Criteria for operation also included at least two of the following: atrial septal aneurysm, multiple cerebral infarcts, a history of multiple cerebral events, and Valsalva strain before stroke. Before operation, one patient had two shunts (1 patent foramen ovale, 1 intrapulmonary shunt). No intraoperative or postoperative complications occurred, but a few hours after operation transient arrhythmias developed in two patients without atrial fibrillation, hemodynamic instability, or embolism. During a median follow-up of 12.2 months, no patient had recurrent stroke. All patients prospectively underwent brain magnetic resonance imaging and contrast echocardiography with simultaneous transcranial Doppler ultrasonography. A residual right-to-left interatrial shunt, smaller than the preoperative one, was observed in only one patient, whereas no lesion was seen on magnetic resonance imaging. Our study suggests that surgical closure of patent foramen ovale in patients with presumed paradoxic embolism is safe, with no recurrent stroke in the first year of follow-up. Further studies are needed to evaluate the long-term prognosis of patients with versus without operation and to define the role of operation as an alternative to prolonged antithrombotic treatment.

Adult↗
PubMed1999

Surgical correction of patent ductus venosus in three brothers.

We report the presence of a patent ductus venosus in three brothers who underwent surgical correction. Patent ductus venosus was demonstrated by ultrasonography. Portosystemic venous shunt ratios as evaluated by [123I]iodoamphetamine per rectal portal scintigraphy were 67%, 50%, and 77%, respectively. Histologic examination of liver biopsy specimens revealed fatty degeneration in all cases. Portal vein pressure before and after temporarily occluding the patent ductus venosus was estimated by an Anthron P-U catheter introduced into the portal vein via the ligament teres hepatis. Portal venous pressure increased from 10 to 17 cm H2O, 16 to 23 cm H2O, and 14 to 27 cm H2O, respectively. Therefore, banding of the ductus venosus with Teflon tape was attempted to prevent portal hypertension following complete ligation. As a result, portal venous pressures after stricture of the ductus venosus were 12, 21, and 20 cm H2), respectively. Bile acid and liver enzymes decreased and returned to normal within 14 days after surgery. Interestingly, serum concentrations of hepatocyte growth factor (HGF) increased significantly after restoration of the portal blood flow and then gradually decreased, but remained persistently elevated for at least two weeks in two cases measured after surgical correction. One month after correction, liver function returned to normal as assessed by serological and histological parameters in all cases. These results suggest that it is important to determine whether stricture or complete ligation is indicated for a patent ductus venosus during surgical correction, based on the portal venous pressure after temporal test occlusion of the duct. In addition, HGF may be a useful marker for normalization of hepatic microcirculation after surgery.

Child, Preschool↗
PubMed2003

[Cryptogenic stroke and patent foramen ovale].

A stroke of unknown etiology is commonly referred to as cryptogenic and is diagnosed in a considerable patient population of especially young age. Numerous case-control studies revealed a strong and consistent association between cryptogenic stroke and the presence of a patent foramen ovale. This relationship corroborates paradoxical embolism as likely stroke mechanism in this patient population. In approximately twenty-five percent of patients with cryptogenic stroke, the patent foramen ovale is accompanied by an atrial septal aneurysm, which considerably heightens the risk for recurrent neurological events. Therapeutic measures for secondary prevention in this patient population encompass medical treatment with antiplatelet agents or anticoagulants and surgical or percutaneous closure of patent foramen ovale. Currently, randomised clinical studies compare medical treatment with closure of patent foramen ovale to determine the most effective treatment strategy in this patient population.

Administration, Oral↗
PubMed2003

Incidence of patent furcal accessory canals in permanent molars of a Turkish population.

AIM: To determine the incidence of patent furcal accessory canals in permanent molars of a Turkish population. METHODOLOGY: Two-hundred extracted teeth consisting of 50 maxillary first molars, 50 maxillary second molars, 50 mandibular first molars and 50 mandibular second molars from Turkish patients attending the Oral Surgery Department of the Faculty of Dentistry, Istanbul University, Istanbul, Turkey, were included in the study. After preparation of access cavities and removal of pulp tissue, the teeth were stored in 5.25% sodium hypochlorite for 1 h. Following double-sealing of the access cavities, all tooth surfaces except the furcation regions were covered with nail varnish. The teeth were stored in 0.5% basic fuchsin for 1 week. The teeth were sectioned at the cemento-enamel junction and the presence of patent furcal canals was established by examining the pulp chamber floor with a stereomicroscope (10x) to determine staining. RESULTS: Patent furcal accessory canals were detected in 24% of maxillary first molars, 16% of maxillary second molars, 24% of mandibular first molars, and 20% of mandibular second molars. No statistically significant differences were found between the tooth types. CONCLUSIONS: In a Turkish population, the incidence of patent furcal accessory canals on the pulp chamber floor of maxillary and mandibular first and second molars ranged between 16 and 24%.

Dental Pulp Cavity↗
PubMed1997

Persistent patent urachus with allantoic cyst: a case report.

Patent urachus results when there is a persistence of an allantois remnant which normally undergoes atresia during embryological development. It can lead to an abdominal wall defect similar in appearance on ultrasound to an omphalocele. A 34-year-old primigravida presented at 19 weeks' gestation for evaluation of a cystic mass arising at the umbilical cord insertion. The initial impression of the referring physician was an omphalocele. The mass arose from the abdominal wall and the umbilical cord inserted into the membranous covering of the mass, which appeared to be fluid-filled and separate from but contiguous with the urinary bladder. Serial sonography followed the progression of the abdominal wall mass. At term, the patient underwent primary Cesarean section with delivery of a 4494-g male infant. The infant underwent repair and closure of the patent urachus and plastic reconstruction of the abdominal wall. When the urachus remains patent, it can lead to a urinary fistula which mimics the ultrasound appearance of an omphalocele. However, patent urachus is associated with a much lower rate of abnormalities than omphalocele, yielding a better fetal prognosis.

Adult↗
PubMed1988

Prevalence of patent foramen ovale in patients with stroke.

The cause of ischemic stroke in younger adults is undefined in as many as 35 percent of patients. We studied the prevalence of patent foramen ovale as detected by contrast echocardiography in a population of 60 adults under 55 years old with ischemic stroke and a normal cardiac examination. We compared the results with those in a control group of 100 patients. The prevalence of patent foramen ovale was significantly higher in the patients with stroke (40 percent) than in the control group (10 percent, P less than 0.001). Among the patients with stroke, the prevalence of patent foramen ovale was 21 percent in 19 patients with an identifiable cause of their stroke, 40 percent in 15 patients with no identifiable cause but a risk factor for stroke, such as mitral valve prolapse, migraine, or use of contraceptive agents, and 54 percent in 26 patients with no identifiable cause (P less than 0.10). These results suggest that because of the high prevalence of clinically latent venous thrombosis, paradoxical embolism through a patent foramen ovale may be responsible for stroke more often than is usually suspected.

Adult↗
PubMed2001

Reoperative coronary bypass surgery: effect of patent grafts and retrograde cardioplegia.

OBJECTIVE: To determine the effects of patent or diseased aorta-coronary bypass grafts and retrograde cardioplegia on mortality during reoperative coronary bypass surgery. METHODS: We conducted a retrospective review of prospectively gathered data, supplemented by systematic chart review, of all patients (n = 744) undergoing reoperative coronary bypass surgery at our institution between 1990 and 1997. Independent predictors of survival were determined by stepwise logistic regression analysis. RESULTS: At least one patent or stenosed graft to the left anterior descending artery was present in 50% of patients, to the circumflex territory in 27% of patients, and to the right coronary artery territory in 33% of patients. The previous left anterior descending graft was a saphenous vein in 82% and a left internal thoracic artery in 18% of patients. In-hospital mortality occurred in 42 (5.6%) patients. Patent or diseased grafts of any coronary artery territory did not significantly increase the risk of mortality. Retrograde cardioplegia use increased in more recent years, was more frequent in patients with stenosed grafts, and was associated with improved survival. Independent predictors of mortality were as follows (with odds ratios and 95% confidence intervals in parentheses): failure to use retrograde cardioplegia (odds ratio 2.81; 1.28-6.20), New York Heart Association class (odds ratio 2.69; 1.25-5.81), peripheral vascular disease (odds ratio 2.60; 1.25-5.41), and left ventricular grade (2.07; 1.31-3.27). CONCLUSIONS: In this series, patent or stenosed grafts were not associated with an increased risk of mortality during reoperative coronary bypass surgery, possibly because of increased use of retrograde cardioplegia in this patient group. We strongly recommend the routine use of retrograde cardioplegia during redo coronary bypass surgery.

Coronary Artery Bypass↗
PubMed2002

Paradoxical air embolism from patent foramen ovale in scoliosis surgery.

STUDY DESIGN: A case was reported in which paradoxical air embolism arose from the patent foramen ovale in scoliosis surgery. OBJECTIVES: To present a case of suspected paradoxical air embolism after scoliosis surgery. SUMMARY OF BACKGROUND DATA: Embolic accident during scoliosis surgery may be caused by air, thrombus, or fat. There is growing attention on patent foramen ovale involved in paradoxical embolism. The devastating consequences are caused by multiple artery occlusions. METHODS: Details of a recent documented neurologic complication (paraplegia, weakness of right arm, and blurry vision) after scoliosis surgery have been analyzed in medical publications. RESULTS: The surgical procedure was not imputed. The causative role of epidural catheter for analgesia was considered, but it is likely that a paradoxical embolism occurred in this case, based on the multifocal (cerebral and spinal) neurologic dysfunction, the evidence of cerebral ischemia (on computed tomography), and the presence of a patent foramen ovale (on postoperative transesophageal echocardiography). Although no intraoperative embolism detection was available, air embolism was highly suspected because there was no absolute argument to exclude cruor or fatty embolism. CONCLUSIONS: It is critical to detect a patent foramen ovale before surgery and cerebral embolization intraoperatively. This might permit ascertainment of the etiologic diagnosis in case of a complication in surgery for scoliosis.

Arthrodesis↗
PubMed2003

Factor V Leiden and prothrombin gene mutation may predispose to paradoxical embolism in subjects with patent foramen ovale.

The role of paradoxical embolism through patent foramen ovale as a mechanism of cryptogenic stroke is controversial. If a venous source of emboli is relevant, prothrombotic states should be associated with patent foramen ovale and cryptogenic stroke. We assessed the occurrence of several prothrombotic states (factor V Leiden, prothrombin G20210A, deficiencies in protein S, protein C and antithrombin, lupus anticoagulant, anticardiolipin antibodies, elevated factor VIII, resistance to activated protein C) and classical risk factors for venous thrombosis in 57 adult patients with cryptogenic stroke and patent foramen ovale and in 104 matched controls. Prothrombotic states [odds ratio (OR) 2.8; 95% confidence interval (CI), 1.2-6.5; P = 0.021], migraine with aura (OR 4.4; 95% CI 1.8-10.8; P = 0.001) and classical risk factors for venous thrombosis (OR 2.5; 95% CI 1.1-5.7; P = 0.037) were independent risk factors for cryptogenic stroke. In particular factor V Leiden or prothrombin G20210A associated with cryptogenic stroke (P = 0.022) whereas other coagulation abnormalities did not (P = 0.140). Among the patients with prothrombotic states, Valsalva manoeuvre was common at onset of stroke. Our results support the possibility of paradoxical embolism behind strokes in patients with patent foramen ovale.

Adolescent↗
PubMed2006

Patent foramen ovale as lifesaving purging valve.

Patent foramen ovale is considered as a potential risk factor for stroke owing to paradoxic embolism, leading to the question "to close or not to close the patent foramen ovale". We report a 26-year-old woman with chest pain, dyspnoea, sudden severe pain in both legs and paraplegia. Thoracic and abdominal computed tomography revealed massive pulmonary embolism and complete obstruction of the abdominal aorta. Interventional removal of the aortic thrombus was undertaken using the Fogarty catheter technique via the femoral arterial approach. As a result of worsening of cardiopulmonary function during the procedure, additional local thrombolysis, with a total of 50 mg recombinant tissue plasminogen activator, and fragmentation of the thrombus in the right pulmonary artery were performed via a femoral vein approach. Ultrasound studies revealed a patent foramen ovale of about 12 mm diameter with a significant right to left shunt. Under favourable conditions, a patent foramen ovale may allow the escape of a thrombus, sufficient to cause a potentially fatal pulmonary embolism, into the arterial system, where it can be removed by interventional manoeuvres.

Adult↗
PubMed2006

Anaphylactic reaction to patent blue V after sentinel lymph node biopsy.

BACKGROUND: We report a documented grade III IgE-mediated hypersensitivity reaction associated with the use of 2.5% patent blue V dye for sentinel lymph node biopsy during breast cancer surgery. METHODS: Immediately after the reaction, when hemodynamic stability was obtained, plasma histamine was measured whereas serum tryptase was not. Six weeks later, with the patient's consent, cutaneous tests to patent blue V dye, methylene blue dye, latex and all drugs used during surgery were performed according to standardized procedures. RESULTS AND CONCLUSION: Clinical symptoms, biological assessment results and cutaneous tests positivity confirmed the onset of an anaphylactic reaction due to patent blue V. Of interest, the positivity of the cutaneous tests observed with patent blue V was not found with methylene blue which might be proposed for further investigations in our patient. This case report confirms the need for systematic allergological investigation of all drugs and substances administered during the peri-operative period in case of an immediate hypersensitivity reaction occurring during anesthesia.

Anaphylaxis↗
PubMed1994

Patent foramen ovale in young stroke patients with mitral valve prolapse.

Because mitral valve prolapse and patent foramen ovale are supposed to promote stroke in young patients, we assessed the frequency of patent foramen ovale in 18 patients younger than 45 years with stroke and mitral valve prolapse diagnosed on echocardiography at the time of stroke, who were admitted to 2 university hospitals. Eleven patients were called back to hospital for contrast transthoracic and/or transesophageal echocardiography, 3 to 7 years after their initial stroke. A patient foramen ovale was found in 9 patients (50%). In 4 re-assessed patients no mitral valve prolapse was found using our present criteria. Six patients with mitral valve prolapse had a patent foramen ovale (43%). Our results suggest that mitral valve prolapse is commonly associated with patent foramen ovale in young stroke patients.

Adolescent↗
PubMed1977

Choroidal absorption angiography with patent blue V.

The vital dye patent blue V is used as a negative contrast dye in order to obtain information about the vascular filling events of the choroid in relation to the retinal circulation and the papilla employing intravenous injection and serial photography. Patent blue is bound to plasma proteins to a limited degree and the angiograms therefore do not only picture the choroidal vessels but also reveal the filling of the choriocapillaris and the transcapillary exchange. It is demonstrated by microdensitometry that the patent blue leakage and subsequent reabsorption is rapid, and that the choroidal dilution curve almost parallels that of the retinal vessels. Our measurements might indicate a diffusion of patent blue from the choroid to the papillary tissue.

Blood Proteins↗
PubMed1994

Effects of a patent foramen ovale on arterial saturation during exercise and on cardiovascular responses to deep breathing, Valsalva manoeuvre, and passive tilt: relation to history of decompression illness in divers.

OBJECTIVE: To determine whether the presence of a patent foramen ovale could result in significant arterial desaturation and affect the responses of heart rate and blood pressure to physiological manoeuvres and to determine whether responses differed between those with and those without prior clinical events associated with a patent foramen ovale. DESIGN: Blind controlled study. SETTING: Teaching hospital. PATIENTS: Divers with a large patent foramen ovale shown by contrast echocardiography and divided into those who had neurological decompression illness that started within 30 minutes of surfacing (group 1), those who had no history of decompression illness (group 2), and age and sex matched control divers who had no evidence of intracardiac shunts (group 3). MAIN OUTCOME MEASURES: The change in percentage haemoglobin oxygen saturation during treadmill exercise and the response of heart rate and blood pressure to physiological manoeuvres. RESULTS: There were no significant differences between the three groups but two divers in group 1 showed clinically important desaturation during exercise and unusual blood pressure and heart rate responses to passive tilt. These divers were notable for having the greatest number of episodes and the most severe single episode of spinal cord decompression illness. CONCLUSION: A large patent foramen ovale may be associated with clinically significant arterial desaturation and unusual responses of heart rate and blood pressure in some healthy subjects.

Arteries↗
PubMed2001

Endovascular stent-graft in abdominal aortic aneurysms: the relationship between patent vessels that arise from the aneurysmal sac and early endoleak.

PURPOSE: To determine the association of patent sac branch vessels (lumbar and inferior mesenteric arteries [IMAs]) with early endoleak rate after stent-graft repair of abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: Pre- and postoperative computed tomographic (CT) angiograms in 158 patients who underwent stent-graft AAA repair were retrospectively reviewed to determine the preoperative patency of IMAs and other sac branch vessels (feeders) and presence or absence of immediate postoperative endoleak. Relationships of early endoleak rate with total branch vessel, IMA, and lumbar artery patency and graft type were evaluated. RESULTS: There was a significant association between patency of sac feeders and rate of early endoleak, especially type 2. As total patent feeders increased from zero to three to four to six, total endoleak rate increased from 6% (one of 17) to 35% (30 of 86); type 2 endoleak rate, from 0% to 25%. IMA patency was significantly associated with total early endoleak rate. Increasing lumbar artery patency also was associated with significantly higher total and type 2 endoleak rates: With zero to three lumbar arteries, the total endoleak rate was 17% and type 2 endoleak rate was 13%, as compared with 60% and 50%, respectively, with more than six patent lumbar arteries. CONCLUSION: Sac branch vessel patency is associated with significantly higher early total and type 2 endoleak rates after stent-graft repair of AAAs; thus, patent sac branches play an important role in the pathogenesis of endoleaks.

Aged↗
PubMed2001

Should one use echocardiography or contrast transcranial Doppler ultrasound for the detection of a patent foramen ovale after an ischemic cerebrovascular accident?

Patent foramen ovale is frequently associated with embolic cerebrovascular accidents. The diagnosis of patent foramen ovale is easier since the advent of transesophageal echocardiography. However, this method is semi-invasive and is not readily available in all units. Contrast transcranial Doppler ultrasound enables the detection of the passage of a contrast material injected into a peripheral vein to the cerebral circulation across an orifice which is most often a patent foramen ovale. Contrast transcranial Doppler ultrasound may facilitate, with a high sensitivity and specificity, the diagnosis of a patent foramen ovale when a transesophageal echo is not possible. However, transesophageal echocardiography remains the preferred test especially in the young since other potentially embolic sources, such as a thrombus in the left atrium, may be demonstrable.

Echocardiography↗
PubMed2005

Prevalence and size of directly detected patent foramen ovale in migraine with aura.

BACKGROUND: Transcranial contrast Doppler studies have shown an increased prevalence of right-to-left shunts in patients with migraine with aura compared with controls. The anatomy and size of these right-to-left shunts have never been directly assessed. METHODS: In a cross-sectional case-control study, the authors performed transesophageal contrast echocardiography in 93 consecutive patients with migraine with aura and 93 healthy controls. RESULTS: A patent foramen ovale was present in 44 (47% [95% CI 37 to 58%]) patients with migraine with aura and 16 (17% [95% CI 10 to 26%]) control subjects (OR 4.56 [95% CI 1.97 to 10.57]; p < 0.001). A small shunt was equally prevalent in migraineurs (10% [95% CI 5 to 18%]) and controls (10% [95% CI 5 to 18%]), but a moderate-sized or large shunt was found more often in the migraine group (38% [95% CI 28 to 48%] vs 8% [95% CI 2 to 13%] in controls; p < 0.001). The presence of more than a small shunt increased the odds of having migraine with aura 7.78-fold (95% CI 2.53 to 29.30; p < 0.001). Besides patent foramen ovale prevalence and shunt size, no other echocardiographic differences were found between the study groups. Headache and baseline characteristics did not differ in migraine patients with and without shunt. CONCLUSIONS: Nearly half of all patients with migraine with aura have a right-to-left shunt due to a patent foramen ovale. Shunt size is larger in migraineurs than controls. The clinical presentation of migraine is identical in patients with and without a patent foramen ovale.

Adult↗